Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders

Ane Bull Iversen; Rolf Ankerlund Blauenfeldt; Søren Paaske Johnsen; Birgitte F Sandal; Bo Christensen; Grethe Andersen; Morten Bondo Christensen

doi:10.1177/2396987320945834

Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders

Eur Stroke J. 2020 Dec;5(4):351-361. doi: 10.1177/2396987320945834. Epub 2020 Aug 6.

Authors

Ane Bull Iversen^{1

2

3}, Rolf Ankerlund Blauenfeldt¹, Søren Paaske Johnsen⁴, Birgitte F Sandal⁵, Bo Christensen^{2

3}, Grethe Andersen¹, Morten Bondo Christensen^{2

3}

Affiliations

¹ Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark.
² Research Unit for General Practice, Aarhus C, Denmark.
³ Department of Public Health, Aarhus University, Aarhus C, Denmark.
⁴ Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
⁵ Department of Neurology, Regional Hospital of West Jutland, Holstebro, Denmark.

Abstract

Introduction: Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke.

Patients and methods: We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke.

Results: We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (OR_patients 2.10; 95% CI 1.12-3.95 and OR_bystanders 22.60; 95% CI 4.98-102.67), <3 h from onset to arrival (OR_patients 3.01; 95% CI 1.46-6.21 and OR_bystanders 4.44; 95% CI 1.37-14.39) and initiation of reperfusion therapy (OR_patients 3.08; 95% CI 1.23-7.75 and OR_bystanders 4.70; 95% CI 1.14-19.5).Conclusion: Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.

Keywords: Acute ischaemic stroke; emergency medical services contact; help-seeking behaviour; intracerebral haemorrhage; prehospital delay; reperfusion therapy; stroke knowledge.